| NPI | 1790385482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE J STAIR TESSNESS Senior Accountant 701-712-5125 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2020-10-30 |